Healthcare Provider Details

I. General information

NPI: 1255706578
Provider Name (Legal Business Name): NRA NUTRITIONAL CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13124 ROCKAWAY BLVD
SOUTH OZONE PARK NY
11420-2932
US

IV. Provider business mailing address

897 STANTON AVE
NORTH BALDWIN NY
11510-2443
US

V. Phone/Fax

Practice location:
  • Phone: 516-567-5176
  • Fax:
Mailing address:
  • Phone: 516-567-5176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number002799-1
License Number StateNY

VIII. Authorized Official

Name: MS. NORMA A REID-ARCHIBALD
Title or Position: OWNER
Credential: RD
Phone: 516-567-5176